It is well documented that smokeless tobacco use is a major risk factor for a variety of oral pathoses such as gingival recession, leukoplakia and cancers of the mouth and pharynx. Rural Appalachians are at risk for tobacco-related diseases and very little is known about their smokeless tobacco use characteristics, especially as these variables relate to oral health status. The purpose of this NIDCR Clinical Trial Pilot Grant are to compare the oral health status of rural adult Appalachian smokeless tobacco users and never-users, characterize smokeless tobacco consumption patterns, and refine a scientifically-valid AHRQ cessation intervention for use with smokeless tobacco users. Oral health indicators that determine the success of the intervention will be developed and tested. The intervention combines existing local agencies, such as a County Nurse and a County Extension Agent, with a lay facilitation model, and may represent an effective mechanism for reaching rural populations. Two rural Appalachian counties in the State of Ohio will participate in this study. One county will be assigned to an intervention, while the other will serve as the control county. Eligible adult smokeless tobacco users in both counties will be assessed for oral health status and smokeless tobacco use characteristics. Intervention county residents will receive a locally-based cessation intervention that will be managed by the County Nurse in the intervention county and delivered by trained lay educators. The County Extension Agent will be responsible for recruitment and retention efforts in this project. At end-of-treatment, and 6 and 12 months, participants from the intervention and control counties will be reassessed for tobacco use, using self-report and biochemical confirmation by saliva cotinine analysis. Comparisons of quit rates will be performed by Chi-square statistical techniques to detect a treatment effect. Multivariate logistic regression analyses will be performed to describe a model of quitter versus continuing user. Oral health status will also be evaluated at 12 months post intervention.